Summaries of health policy coverage from major news organizations

In contemporary India, "a combination of
cultural taboos and a lack of education" hinder efforts to stem the country's HIV/AIDS epidemic, today's Washington Post reports in a feature story. While less than 1% of the country's population is HIV-positive, India has the second-largest number of HIV-infected people in the world. Estimates for the number of Indians with HIV range from 3.5 million to four million, and the country's large population makes the impact of the disease, and its potential to spread rapidly, "costly and potentially devastating." In addition, cultural taboos that discourage open discussion of sex are "extremely strong," according to Akshay Kolukor, president of the regional branch of the Network for Positive People. International agencies and the Indian government have launched "intensive efforts" to target "vulnerable populations" most at risk for acquiring the disease, including migrant workers, truck drivers, prostitutes and members of Bombay's "hidden but active gay community." One group, for example, distributes free condoms and gives free medical checkups from a van at a central truck stop, another sends counselors to educate prostitutes on the disease, and a third offers private HIV testing and information for homosexuals. The government and health groups have also launched education and prevention efforts that target people in rural areas and major cities. An estimated 73% of Indians live in rural areas, where most "know little" about AIDS, while people in urban areas "are afraid to be identified because the disease is associated with sexual behavior, contagion and death."

Question of Drugs
Although antiretroviral drugs are "inexpensive and widely available" in India, many people are not aware that they exist, and an even greater number cannot afford them. Government health policies "stress prevention over treatment," the Post reports, and only a "tiny" portion of HIV-positive people are treated with anti-AIDS drugs. In addition, doctors may not be able to carefully monitor the drug regimens of a "transient patient population," which could end up experiencing harmful side effects from drugs if they are not taken correctly. Doctors and analysts feel that even though prevention and education efforts are making headway, the "new awareness [of HIV/AIDS] has failed to translate into effective medical treatment," since many
HIV-positive individuals are "often afraid to seek treatment," and many others cannot afford it. I.S. Gilada, a physician who operates several clinics for HIV testing and AIDS treatment, said, "Better access to information and care is just as important as lower drug prices. Ninety percent of patients still don't know they have [the virus], and there is no patient lobby in India because of the social stigma. Even if you provide these drugs at one-tenth the cost, you will never reach everyone who needs them." Bitra George, a New Delhi physician who treats STDs and AIDS, added, "There is a three-tiered war going on here: an international war over pharmaceutical prices, a national war over drug and health policies and a grassroots war over information and attitudes about AIDS." Doctors fear that unless the stigma in India concerning AIDS is confronted and lessened, the country's HIV population will continue to rise. Yusuf Hamied, chair of generic AIDS drug maker Cipla Ltd., said, "AIDS is a foreseen tragedy. In five years we will probably have 35 million HIV-positive people. If we do nothing about it, India will become another Africa, and then it will be too late" (Constable, Washington Post, 3/7).

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